hCG or Progesterone Effect on Unexplained Recurrent Pregnancy Loss
Overview
- Phase
- Phase 2
- Intervention
- Progesterone Pill
- Conditions
- Recurrent Pregnancy Loss Without Current Pregnancy
- Sponsor
- Wake Forest University Health Sciences
- Primary Endpoint
- Miscarriage
- Status
- Withdrawn
- Last Updated
- 3 years ago
Overview
Brief Summary
Up to half of all cases of recurrent pregnancy loss are unexplained (uRPL). Evidence points towards endometriosis and progesterone resistance as an underlying cause of uRPL. Previous non-RCT studies have suggested the luteal hCG provides a useful treatment for uRPL. We propose performing a randomized controlled trial to compare mid-luteal hCG with oral progesterone to prevent early pregnancy losses. the endpoint will be ongoing pregnancy and live birth rates. Equal numbers of patients will be randomized to each group.
Detailed Description
Fifty (50) patients with unexplained recurrent pregnancy loss, defined as 2 or more losses. Workup will exclude structural, genetic, hormonal, and anti-phospholipid syndrome-related causes of RPL. Women with unexplained RPL will be randomized to receive a mid-luteal injection of ovidril (250 ug) 1 week after ovulation vs prometrium (200 mg qhs) starting 4 days after ovulation. If pregnant, prometrium will be continued until 8 weeks of pregnancy. If pregnancy does not occur, subjects will be allowed to repeat this protocol for up to 3 cycles. Outcomes will be listed as "not pregnant", "biochemical pregnancy", "miscarriage" or "ongoing pregnancy" for each cycle. Endpoints of pregnant cycles will be compared for pregnancy rate, miscarriage rate, ongoing pregnancy rate and live birth rate.
Investigators
Eligibility Criteria
Inclusion Criteria
- •2 first trimester losses
- •unexplained recurrent pregnancy loss
Exclusion Criteria
- •Antiphospholipid syndrome
- •uterine septum
- •Asherman's syndrome
- •Paternal or maternal genetic abnormalities (i.e. balanced translocation)
- •Endocrine causes of RPL (thyroid, diabetes, hyperprolactinemia)
Arms & Interventions
Progesterone
Women receive prometrium 200 mg qhs for up to 8 weeks
Intervention: Progesterone Pill
hCG
A single shot of hCG (ovidril 250 ug) will be given as a subcutaneous injection 1 week after ovulation
Intervention: hCG
Outcomes
Primary Outcomes
Miscarriage
Time Frame: 4 to 11 weeks
Loss of pregnancy before 11 weeks of pregnancy
Ongoing pregnancy
Time Frame: 8 weeks
Successgful pregnancy beyond 8 weeks of gestation with a heart beat
Secondary Outcomes
- Live birth rate(40 weeks)